Coagulation
1.
Rotation Name
Coagulation
2.
Educational Purpose of the Rotation
Clinical experience is provided in an inpatient and outpatient setting with fellows
participating in three half day outpatient clinics, consisting of six to eight patients
per clinic, presenting a variety of hematologic conditions: anemia,
thrombocytopenia, porphyria, hemochromatosis, hemoglobinopathy, etc., in
addition to the many thrombotic and hemorrhagic disorders. Approximately a
third of the patients seen in these clinics will be new to our service, requiring an
extensive evaluation.
In addition to these clinics, the fellows will participate in a monthly half day clinic
for patients with hemophilia, von Willebrand’s disease and related inherited
bleeding disorders. This comprehensive bleeding disorders clinic is staffed by
six health care professionals and is funded by the Department of Health and
Education through the Hemophilia Foundation of Michigan.
3.
Staffing of the Rotation
Attending faculty member – Dr. John Penner
4.
Resources
Outpatient clinics are housed in the MSU Bleed Disorders Clinic at the MSU
Clinical Center.
5.
Patients
The attending physician maintains ultimate responsibility for patient care.
Residents are exposed to a variety of hematologic conditions including anemia,
thrombocytopenia, porphyria, hemochromatosis, hemoglobinopathy in addition to
the many thrombotic and hemorrhagic disorders.
6.
Responsibilities
On the clinical services, the fellow will see the patient independently, obtain
history and do a physical examination, before discussing the case with the
attending physician, Dr. Penner.
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7.
Instructional Methods
Faculty members teaching the hematology residents are responsible for:
1.
2.
3.
4.
8.
Supervision of the resident in accordance with the supervision policy.
Responding promptly to the resident’s questions/concerns.
Providing the resident with ongoing performance feedback and skill
progression.
Increasing the level of responsibility as the individual skill level
progresses.
Evaluation
At the end of the rotation, fellows will be expected to have a knowledge of basic
mechanisms involved in blood coagulation, the pathophysiology of thrombosis
and hemostasis, and thorough knowledge of therapeutic agents employed to
manage hemostatic, as well as thrombotic disorders.
Specific disorders covered during rotation are as follows:
1.
Hypercoagulability and the inherited thrombophilic disorders
a.
b.
c.
d.
e.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Factor V Leiden
Prothrombin 20210
Anti-thrombin III deficiency
Protein C and S deficiency
Homocysteinemia
Thrombotic thrombocytopenic purpura
Hemolytic uremic syndrome
Disseminated intravascular coagulopathies
Heparin induced thrombocytopenia
Hemophilia A and B
von Willebrand’s disorder
Thrombocytopathias
Autoimmune thrombocytopenias and refractory autoimmune
thrombocytopenia
Therapeutic agents employed for hemostasis
a. platelet concentrates
b. fractionated plasma products
c. recombinant concentrates of Factor VIII, IX, VIIA, Prothrombin complex
concentrates
Therapeutic anticoagulant products
a. Heparin
b. low molecular weight heparins
c. direct thrombin inhibitors (Argatroban, Leparudin)
Warfarin products, as well as Indandiones
Antiplatelet agents
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a.
b.
c.
d.
e.
Aspirin
Clopidogrel
Ticlopidine
Abciximab
Dipyridamol
14. Fibrinolytic agents
a. Streptokinase
b. Urokinase
c. Tissue plasminogen activators
15. Fibrinolytic inhibitors
a. Trasylol
b. Amicar
9.
Clinical Oncology - Rotation Competency Objectives
1.
Patient Care
a) By the conclusion of the rotation, the Hematology/Oncology Resident
will demonstrate the ability to perform an appropriate oncology history
and physical, documenting the findings in an appropriate consultative
summary, with a differential diagnosis list.
b) By the conclusion of the rotation, the Hematology/Oncology Resident
will be able to perform the above skills and be able to independently
generate an appropriate management plan.
c) Demonstrate the ability to complete an efficient work up inclusive of
history and physical, diagnostic procedures, problem list, working
diagnosis and treatment plan.
d) Follow assigned patients appropriately.
e) Demonstrate the ability to respond appropriately to abnormal test
results.
2.
Medical Knowledge
a) All residents will be evaluated by the supervising faculty for appropriate
analytic approach to oncologic conditions. These include solid tumors
including tumors of the lung, breast, bowel, ovary, uterus and other
organs as well as hematopoetic malignancies such as lymphomas and
leukemias. Residents will be evaluated for satisfactory basic and
clinical knowledge of medical aspects of oncology.
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b) Demonstrate a sound knowledge base pertinent to the field of
hemostasis and thrombosis.
3.
Interpersonal and Communication Skill
a) Residents are expected to demonstrate professional communication
skills throughout their interactions with oncology patients. In addition,
residents will be assessed for appropriate communication with MSU’s
office staff, including setting clear expectations for work hours and
outpatient/inpatient duties. Residents will be expected to act as a
constructive and proactive member of the practice.
b) Demonstrate the ability effectively work with other members of the
heath care team including other residents, attending physicians and
other health care provides.
c) Communicate effectively with patients and their families
4.
Professionalism
a) Throughout the rotation, residents are expected to exhibit reliability in
their clinical duties, as well as integrity and respect in their interactions
with patients and colleagues.
b) Residents will be able to demonstrate appropriate consultative
principles of communication and responsiveness to professional
consultative requests.
5.
Practice Based Learning and Improvement
a) Rotating residents will demonstrate self-initiative in the use of
information technology available via the MSU electronic library to
access and retrieve materials for self-education via computer terminals
located in the resident offices and throughout the clinic.
b) Rotating residents will be expected to show progressive learning
throughout the rotation, with emphasis on learning from any cognitive
or procedural errors. They are also expected to facilitate any quality
improvement initiatives in place at MSU’s clinical office practice.
6. Systems Based Practice
a) All residents will demonstrate conscientious awareness of the impact
of their professional activities at the MSU office practice site, and will
conscientiously avoid inappropriate use of the practice resources.
b) Residents must demonstrate understanding of cost-effectiveness of
care incorporating cost-effectiveness into their development of
diagnosis and treatment plans.
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